Serial casting is a non-invasive technique used to reduce muscle tightness and limited range of motion of a joint to improve a person’s function, when manual stretching techniques are ineffective.
For purposes of the blog, we will be using the ankle as our reference with regards to toe walking in children, but serial casting can be used for a wide range of diagnoses and for a wide variety of joints.
Serial casting involves a child wearing a short leg cast (below the knee down to the foot), that positions the foot into a dorsiflexed (foot/toes pointed up towards the sky) position to put a prolonged stretch on the calf muscles. Typically, weekly check-ins are needed with the possibility of a new cast being placed to increase the stretch as tolerated. This entire process typically takes 4-8 weeks. Sometime during one of the check-ins, an orthotist will take a mold of your child’s foot and ankle to create a short leg brace called an ankle foot orthosis (AFO) that your child will wear once your casts are officially off. The AFO helps keep the foot and ankle in proper alignment while also preventing them from being able to plantar flexing their feet (i.e. pointing their foot/toes toward the ground). Your child will continue to be followed by the team who performed serial casting so they are able to make adjustments to the braces as needed and decide if another round of serial casting is needed.
Your child may need another round of serial casting after periods of growth as the muscle does not stretch as fast as the bones grow, reducing the range of motion, or if there is not compliance with a home exercise program which typically consists of wearing the orthosis and performing stretching/strengthening exercises.
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